This article was awarded the Solutions Journalism prize, co-sponsored by Transitions, at the ninth annual Czech Journalism Awards on 2 May. The goal of solutions journalism is to deliver rigorous and evidence-based reporting on responses to social problems and bring deeper insights to complex issues while keeping a critical distance and identifying the limits of the chosen approach.

Petr lives in a village in the Czech Republic’s South Moravia region. Now 46, he’s been in a wheelchair since childhood. “It wasn’t from a congenital disease or an accident. The doctors made a mistake when I was born. They didn’t realize there were two of us in Mama’s belly. My sister was born first and after a while they noticed I was still in there. As they rushed to get me out, the umbilical cord got twisted around my neck and strangled me a little. I suffered brain damage, I have muscle spasms all over my body, and I can’t keep my balance.”

He always yearned to be in a relationship. “I wanted to know what it’s like to have a beautiful woman by my side whom I could touch, caress, finally have at least a little erotic experience like healthy people do.” But he was never able to find a partner.

Three years ago, five female sexual assistants specially trained for work with the handicapped started working in the Czech Republic. When Peter heard about them, he didn’t hesitate to find out more. An assistant visits him once a month. “She makes it possible to experience beautiful moments, and I can chat with her about anything. She brings me at least a little bliss. I wouldn’t have believed it, but she has really improved my quality of life. Physically, and most importantly psychologically, I feel much better.”

Breaking Down Barriers

Many myths circulate about the sex lives of the handicapped. “Either they are completely asexual and don’t require sexual experiences, or the opposite, they’re hypersexual. Neither version is true,” says Lucie Sidova, a therapist and co-founder of the non-profit association Freya. She helped launch the Czech sexual assistance program as head of Rozkos bez rizika (Bliss Without Risk), a health and counseling service for sex workers, which trained the first five professional assistants in 2015.

Inspiration for the program came from similar initiatives in Germany and Switzerland. Applicants first filled out a questionnaire and then underwent a detailed interview. “The most important thing was that they weren’t motivated just by money, that the work meant more than that. And that they were at ease with their own sexuality,” says Sidova. “We made the selection from women we knew and trusted.” Most already had experience as paid sex workers, others as tantric or erotic masseuses. All had at one time or another had handicapped clients. Today, none of the women still works in the sex trade.

220: number of sexual assistance sessions provided last year by the five trained women. They offer erotic services and therapy to the elderly as well as the handicapped.

The beginnings were rocky. “This service was new and controversial. We came up against pressure from the public, people were just waiting for us to make a mistake,” says Sidova. Eventually, in the fall of 2015, the Interior Ministry issued a decision that the project did not violate the law, and the sexual assistants were able to undergo training and start working, provided they didn’t stray across the line into procuring.

Image by Nikolai Vassiliev/Flickr.

The assistants work for themselves on the basis of a trade license. Freya offers know-how and advice. Some offer only counseling, others massage, masturbation training, and mutual use of erotic aids, while others are willing to have sexual intercourse. The ethics code, while calling for mutual respect, does not exclude any practice.

Maximum Satisfaction

“Full-figured blonde with big breasts” is how Diana Lovecka presents herself to clients. The 38-year-old visits clients at their homes, in health institutions, or in hotels. On first meeting, she sits down with the client for a chat about what he expects. “I may offer a shared bath, massage, mutual touching, use of sex aids, and other pleasant experiences by common agreement. I always try to go away leaving the client totally satisfied and happy.”

She spends one week each month in the UK, where she cares for a stroke patient. At home, in the Czech Republic, she teaches English and works as a sexual assistant in her spare time.

Do’s and Don’ts: Bliss Without Risk sought legal advice before launching the sexual assistance program to avert any accusation of procuring. Social workers are free to inform clients about the public listings of trained sexual assistants on the internet. When the client chooses an assistant, he may request the social worker to discuss certain matters with the assistant in advance and in some cases accompany him to the initial information session with her – always as the client wishes, as he alone can decide which services to take advantage of. Of course, the client is free to discuss the service with anyone. 

Lovecka prepares for each client individually, based on his individual medical diagnosis. “It’s easy to go too far,” she says. “We have to guard against that. The assistance has to be for the client’s own good.” With handicapped clients, she says it’s usually not difficult to agree on what services she will provide: “They tell me about their situation, explain what they expect.” Diana’s blind client likes to take full control over the session. Pictograms and images help when the client has difficulty speaking. “With mentally handicapped clients I lead the process; I try to work out from their reactions what is pleasant for them. I have to go very slowly, intuitively.” Diana says her biggest challenge was working with a man who was unable to communicate in any way.

One customer told her about that day’s lunch and yesterday’s horseback ride, as though unable to focus on what was happening. “But from his caregiver I know that thanks to the assistance he stopped bothering the other residents in his care home.”

I’m Not a Child

We sometimes see the mentally handicapped as big children in a sexless world. “Even though they may look or act like children, their sexuality hasn’t stopped, it keeps developing. Sometimes caregivers don’t realize this, or don’t want to know,” Sidova says.

This can encourage inappropriate behavior – masturbation in group sessions, sexual assaults – or the person may fall into depression, and start to hate her or his own body. Lucie says some institutions punish expressions of sexuality or suppress it with drugs. “When their caregiver says ‘Ugh, don’t do that,’ they should also tell them how and where they can satisfy their needs in privacy, because no one has ever told them how to do it properly.” Some institutionalized people have never seen a naked body other than their own.

Others are in the care of parents who reject the thought that their child has sexual needs, or aren’t able to allow her or him the space to satisfy those needs. There are exceptions. “One older man called me, crying over the phone, thanking me for offering this service, saying no one could understand what it was like trying to deal with his autistic son’s sexuality alone,” Sidova recalls.

Those with physical disabilities face special obstacles. For some with paralysis or twisted hands it may not be physically possible to satisfy themselves alone. Of course, they can hire a prostitute, at least if they are men. Night clubs may not have barrier-free access, but there are always escorts, if they can find one willing to do this kind of work. And so frustration grows.

Different Paths to the Goal

Achieving sexual satisfaction and self-expression is not always straightforward for people with disabilities. Erogenous zones can be located, even for those who lack feeling in their body: perhaps the earlobes, neck, or head. Imagination plays an important role as well. “Sadomasochistic practices are important for some. Whipping, bondage, and greater pressure can help the body feel at least something,” Sidova says.

The right choice of erotic aid is crucial in some cases. “In our courses, we teach the assistants how to choose aids for clients. Not all vibrators are the same.” Men with severe mental disability sometimes prefer the anal region and may insert inappropriate objects into the rectum. “So it’s important to know about butt plugs, how to choose them and show the client how to care for it properly,” Sidova adds. There are special chairs and swings to help those with physical disabilities. No one is a lost cause.

What About Women?

Women, too, can use the services of sexual assistants, but there is not much demand – understandably, as no men have been trained for the job so far. “I know of two women who have used the service. One wrote us that she felt very safe opening up about sexuality with a woman,” Sidova says. The assistant helped her find her erogenous zones with egg and ring vibrators. If a woman lacks sensation or the ability to use her hand, the assistant guides her hand, slowly moving it over her breasts and sexual organs, helping her discover her own body and arouse herself for the first time.

Handicapped women may not have much longer to wait until the first male assistants start to work. Freya is planning to start training new assistants of both sexes by the end of the year. “We’ve had interest from masseurs and masseuses, and from nurses and social workers. We’re really pleased with this,” Sidova says. Freya’s goal is to make the service available in all parts of the country.

Caution, Fragile

I ask Diana Lovecka what the hardest part of the job is.

“Not to take their stories too much to heart. Realize that when I leave a session, my job is over. I come into contact with a lot of different life stories and tragedies. I have to know how to let go.” She’d rather talk about the positive side. “If it’s a one-time service, it’s enough that the client has a smile on his face at the end.” This is one of the most common effects the assistants talk about: how clients rediscover the joy in life, start laughing again. They become less aggressive. Some even find a partner among fellow residents in their institutions. “In a long-term situation, it’s amazing to watch the client progress,” Lovecka says.

She tells the story of a disabled couple in a long-term relationship whom she was able to help with the physical side of sex. Of a blind man who lost his virginity with her after 30 years and finally grew out of his timidity, so that now he knows he is capable of finding a girlfriend. Or of a man with an accidental injury who stopped believing he could attract a woman or have any kind of sex life. “He reaffirmed that he could still function as a man.”

1,200 crowns ($60): The cost of one hour’s session with a sexual assistant. A big investment for someone on a disability pension – out of reach for many. The assistants determined the fee themselves. They cover travel expenses from their own pockets. “It’s not an easy job and we can’t expect them to work for less. Obviously I’d like it if the service was more affordable. But you can save up for it. Some clients stopped smoking to save money,” Lucie Sidova says.

The ethics code for the job warns against forming emotional bonds with clients. And yet, the barrier around providing sexual assistance as a professional service is not unbreakable. Assistants make clear that they are not partners or girlfriends. But, Sidova remarks, it’s completely natural that a person who for a long time was unable to have a relationship might fall in love. “For someone with a mental disability it could be the first time they ever have this kind of feeling. I think they deserve this. Even people with handicaps have the right to experience sadness and joy. Why should we cut them off from an emotional life? After all, every one of us has experienced disappointment in love.”

To keep the relationship on a businesslike level, the assistant may need to have a talk with her client or in extreme cases ask a colleague to take her place. “It’s already happened once,” Sidova says.

Next Steps

Czech society’s attitude toward the sexuality of disabled people has changed dramatically in the past few years. Taboos are crumbling piece by piece, although there is still a long way to go. It’s hard to disagree with Sidova that everyone should enjoy the right to basic human experiences like sex, intimacy, and the closeness of another person.

“It would be much better if these people found a true partner, someone they could go through life with,” she says. “Sexual assistance is not the solution, just an avenue for those who haven’t been able to fulfill themselves in this way. Something like a launching pad.”

Petra Dlouha has been writing for, a finance news site, and Finmag, an online finance magazine, since 2011. She studied journalism at the Faculty of Social Sciences at Charles University in Prague. During her studies she worked as an intern at the Czech daily Lidove noviny. This article originally appeared on the Czech business news site Finmag. Reprinted with permission. Translated by Ky Krauthamer.